Provider Demographics
NPI:1942031406
Name:TULLIUS, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:TULLIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820A BARZEE RD
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-9561
Mailing Address - Country:US
Mailing Address - Phone:530-591-9676
Mailing Address - Fax:
Practice Address - Street 1:820A BARZEE RD
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-9561
Practice Address - Country:US
Practice Address - Phone:530-591-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-61204174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN